Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study
Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study
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DOI：
10.1093/ofid/ofx171
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发表时间：
2017-09-01
影响因子：
4.2
通讯作者：
McDonald, L. Clifford
中科院分区：
文献类型：
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作者：
Guh, Alice Y.;Adkins, Susan Hocevar;McDonald, L. Clifford
背景。在美国，社区相关 (CA) 艰难梭菌感染 (CDI) 的比例不断增加。我们进行了一项病例对照研究来确定 CA-CDI 危险因素。方法。我们在 2014 年 10 月至 2015 年 3 月期间招募了来自美国 10 个地点的参与者。病例患者被定义为年龄 >= 18 岁、在门诊或住院 3 天内采集的艰难梭菌阳性标本、在过去 12 周内没有住过医疗机构且之前没有 CDI 诊断的人。每个病例患者与一名对照（没有 CDI 的人）相匹配。参与者接受了有关相关暴露的采访；进行多变量条件逻辑回归。结果。在 226 对中，70.4% 为女性，52.2% 为 60 岁以上。与对照组相比，更多病例患者既往接受过门诊医疗保健（82.1% vs 57.9%；P < .0001）和抗生素暴露（62.2% vs 10.3%；P < .0001）。在多变量分析中，抗生素暴露——即头孢菌素（调整匹配比值比[AmOR]，19.02；95% CI，1.13-321.39）、克林霉素（AmOR，35.31；95% CI，4.01-311.14）、氟喹诺酮（AmOR，30.71；95% CI， 2.77-340.05）和 β-内酰胺和/或 β-内酰胺酶抑制剂组合（AmOR，9.87；95% CI，2.76-340.05），-急诊科就诊（AmOR，17.37；95% CI，1.99-151.22），白种人（AmOR 7.67；95% CI， 2.34-25.20）、心脏病（AmOR，4.87；95% CI，1.20-19.80）、慢性肾病（AmOR，12.12；95% CI，1.24-118.89）和炎症性肠病（AmOR，5.13；95% CI，1.27-20.79）与CA-CDI。结论。抗生素仍然是 CA-CDI 的一个重要危险因素，这凸显了适当门诊处方的重要性。急诊科可能是 CDI 的环境来源；需要进一步调查它们对 CDI 传播的贡献。
Background. An increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors.Methods. We enrolled participants from 10 US sites during October 2014-March 2015. Case patients were defined as persons age >= 18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed.Results. Of 226 pairs, 70.4% were female and 52.2% were >= 60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P < .0001) and antibiotic (62.2% vs 10.3%; P < .0001) exposures. In multivariate analysis, antibiotic exposure-that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13-321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01-311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77-340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76-340.05),-emergency department visit (AmOR, 17.37; 95% CI, 1.99-151.22), white race (AmOR 7.67; 95% CI, 2.34-25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20-19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24-118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27-20.79) were associated with CA-CDI.Conclusions. Antibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.